Evaluating Antimicrobial Use and Spectrum of Activity in Ontario Hospitals: Feasibility of a Multicentered Point Prevalence Study

Leung, Valerie; Wu, JH; Langford, Bradley J; Zvonar, Rosemary; Powis, Jeff; Longpre, Julie; Béïque, L; Gill, Suzanne; Ho, Grace; Garber, Gary

doi:10.1093/ofid/ofy110

Cited by 12 publications

(10 citation statements)

References 16 publications

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“…The results were higher than the NAPS in Australian hospitals (30.5%) [ 19 ]. A similar situation or higher rates of surgical antimicrobial prophylaxis >24 h have been reported in other countries (range 52.8–77%) [ 11 , 12 , 20 , 21 , 22 ]. A survey conducted among general surgeons found that failure to keep up to date, reliance on habit rather than on evidence-based practices, personal experience and preference, peer influence, and institutional norms affected their choice of duration of antimicrobials cover [ 23 ].…”

Section: Discussionsupporting

confidence: 82%

“…This was also comparable to the average prevalence observed among hospitals in the neighbouring country, Singapore (51%) [ 8 ]. Figures for the prevalence of antimicrobial consumption to adult hospitalised patients in other PPS studies varied between different regions; 43% in Australia [ 9 ], 56% in China [ 10 ], 32.9% in Europe [ 11 ], 38% in Canada [ 12 ], and 34.4% from the reported data collected across 53 countries [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital

et al. 2021

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Antimicrobial resistance remains a significant public health issue, and to a greater extent, caused by the misuse of antimicrobials. Monitoring and benchmarking antimicrobial use is critical for the antimicrobial stewardship team to enhance prudent use of antimicrobial and curb antimicrobial resistance in healthcare settings. Employing a comprehensive and established tool, this study investigated the trends and compliance of antimicrobial prescribing in a tertiary care teaching hospital in Malaysia to identify potential target areas for quality improvement. A point prevalence survey method following the National Antimicrobial Prescribing Survey (NAPS) was used to collect detailed data on antimicrobial prescribing and assessed a set of quality indicators associated with antimicrobial use. The paper-based survey was conducted across 37 adult wards, which included all adult in-patients on the day of the survey to form the study population. Of 478 patients surveyed, 234 (49%) patients received at least one antimicrobial agent, with 357 antimicrobial prescriptions. The highest prevalence of antimicrobial use was within the ICU (80%). Agents used were mainly amoxicillin/β-lactamase inhibitor (14.8%), piperacillin/β-lactamase inhibitor (10.6%) and third-generation cephalosporin (ceftriaxone, 9.5%). Intravenous administration was ordered in 62.7% of prescriptions. Many antimicrobials were prescribed empirically (65.5%) and commonly prescribed for pneumonia (19.6%). The indications for antimicrobials were documented in the patients’ notes for 80% of the prescriptions; however, the rate of review/stop date recorded must be improved (33.3%). One-half of surgical antimicrobial prophylaxis was administered for more than 24 h. From 280 assessable prescriptions, 141 (50.4%) were compliant with guidelines. Treating specialties, administration route, class of antimicrobial, and the number of prescriptions per patient were contributing factors associated with compliance. On multivariate analysis, administering non-oral routes of antimicrobial administration, and single antimicrobial prescription prescribed per patient was independently associated with non-compliance. NAPS can produce robust baseline information and identifying targets for improvement in antimicrobial prescribing in reference to current AMS initiatives within the tertiary care teaching hospital. The findings underscore the necessity to expand the AMS efforts towards reinforcing compliance, documentation, improving surgical prophylaxis prescribing practices, and updating local antibiotic guidelines.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital

et al. 2021

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“…When possible, total consumption for antibiotics for systemic use (ATC J01 class) should be reported and further stratified by antibiotic classes (J01 subgroup) or individual agents. 15 , 21 , 22 , 40 , 48 Data stratification according to the new AWARE index, introduced by the WHO in the Essential Medicines List, 37 is an alternative to promote benchmarking. 45 , 53 Approaches that are more specific can be considered in the case of predefined outcome measures addressing specific syndromes and/or settings (i.e.…”

Section: Discussionmentioning

confidence: 99%

White Paper: Bridging the gap between human and animal surveillance data, antibiotic policy and stewardship in the hospital sector—practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks

Pezzani

Carrara

Sibani

et al. 2020

Journal of Antimicrobial Chemotherapy

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Background Antimicrobial surveillance and antimicrobial stewardship (AMS) are essential pillars in the fight against antimicrobial resistance (AMR), but practical guidance on how surveillance data should be linked to AMS activities is lacking. This issue is particularly complex in the hospital setting due to structural heterogeneity of hospital facilities and services. The JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks have joined efforts to formulate a set of target actions for linking surveillance data with AMS activities. Methods A scoping review of the literature was carried out addressing research questions on three areas: (i) AMS leadership and accountability; (ii) antimicrobial usage and AMS; (iii) AMR and AMS. Consensus on the target actions was reached through a RAND-modified Delphi process involving over 40 experts in different fields from 18 countries. Results Evidence was retrieved from 51 documents. Initially 38 targets were proposed, differentiated as essential or desirable according to clinical relevance, feasibility and applicability to settings and resources. In the first consultation round, preliminary agreement was reached for 32 targets. Following a second consultation, 27 targets were approved, 11 were deleted and 4 were suggested for rephrasing, leading to a final approved list of 34 target actions in the form of a practical checklist. Conclusions This White Paper provides a pragmatic and flexible tool to guide the development of calibrated hospital-surveillance-based AMS interventions. The strength of this tool is that it is a comprehensive perspective that takes into account the hospital patient case-mix and the related epidemiology, which ultimately drives antimicrobial usage, and the feasibility in low-resource settings.

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“…This would help to identify recurrent problems with antimicrobial use at the institution and frames the problems that need to be addressed [44]. The antimicrobial stewardship efforts should focus on improving adherence to documentation standards, optimizing the use of antimicrobials, appropriateness of drug dosing, halting treatment of asymptomatic bacteria and microbes, and minimizing the length of surgical prophylaxis [45].…”

Section: Antimicrobial Stewardshipmentioning

confidence: 99%

Antimicrobial Resistance and Rational Use of Antimicrobials in Livestock: Developing Countries’ Perspective

Meena¹,

Kumar²

2020

Livestock Health and Farming

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India is one of the top consumers of antibiotics in agriculture worldwide, which accounts for 3% of global consumption, which is estimated to double in 2030. The use of antibiotics, particularly in chickens, is expected to triple in India by 2030. The overuse, injudicious use, and misuse of these antimicrobial drugs have spawned the evolution of life-threatening bacteria that is making the current antimicrobials' reserve useless. Suitable extension outreach and continuing programmes should be devised to promote the judicious use of antimicrobials. Innovative approaches, such as One Health, Antimicrobial Stewardship, and antimicrobial conservation are the need of present alarming situation. There is need to reduce the antimicrobial use in animals, particularly domesticated animals; provision of infection surveillance in hospitals; improving hospital surveillance for monitoring antibiotic resistance; promoting rational and judicious use of drug through education, monitoring, and supervision; researching new drugs; and developing and implementing a more restrictive and participatory antibiotic policy by including various stakeholders. Thus, tracking the rate of veterinary antimicrobial use, resistance, and residues, through a nationwide surveillance and monitoring system, and educating farmers, veterinarians, and consumers could pave the way to fight against this catastrophic situation of antimicrobial resistance.

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Evaluating Antimicrobial Use and Spectrum of Activity in Ontario Hospitals: Feasibility of a Multicentered Point Prevalence Study

Cited by 12 publications

References 16 publications

Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital

Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital

White Paper: Bridging the gap between human and animal surveillance data, antibiotic policy and stewardship in the hospital sector—practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks

Antimicrobial Resistance and Rational Use of Antimicrobials in Livestock: Developing Countries’ Perspective

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